Auditory Hallucinations in Patients With Acquired Hearing Loss: A Case Series

Auditory hallucinations are a common but underrecognized symptom in those with hearing impairment. The pathophysiology is poorly understood but hypothesized to be related to deafferentation phenomenon.

We describe the cases of 2 patients with bilateral acquired hearing loss and no previous history of psychosis who reported distressing auditory hallucinations. Case 1 involves a woman in her 60s who presented with both auditory and visual hallucinations and associated delusions that did not respond to olanzapine but responded well to sertraline and a low dose of quetiapine. Case 2 involves a man in his late 70s with progressively worsening auditory hallucinations with associated delusions who responded well to treatment with risperidone.

Despite centuries of documentation about hallucinations in sensory impairment, its pathophysiology is not completely understood, nor is there consensus regarding treatment.

Health care providers should be aware of the prevalence of auditory hallucinations in those with hearing impairment, particularly when symptoms are misattributed to primary psychotic disorders or neurodegenerative conditions. A biopsychosocial approach, including psychoeducation, behavioral and environmental modifications, and family involvement can yield significant improvement and even resolution of symptoms.